Provider Demographics
NPI:1538570494
Name:YOUNGSTOWN STATE UNIVERSITY STUDENT HEALTH
Entity type:Organization
Organization Name:YOUNGSTOWN STATE UNIVERSITY STUDENT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE-APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSM, ACNS-BC
Authorized Official - Phone:330-941-3489
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44555-8993
Mailing Address - Country:US
Mailing Address - Phone:330-941-3489
Mailing Address - Fax:330-941-3186
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44555-8993
Practice Address - Country:US
Practice Address - Phone:330-941-3489
Practice Address - Fax:330-941-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health